2015-2016 Final Policies

This page contains final policies to the Global Commitment Register (GCR) for the Medicaid program.

• GCR 16-120:
  • Health Care Administrative Rules Update - Adopted Rules (5/26/17)
  • Rules included:
  • 4.204 Medical and Surgical Services of a Dentist
  • 4.220 Chiropractic Services
  • 10.100 Pharmaceutical Manufacturer Fee
  • Effective Date: 5/26/17
  • Health Care Administrative Rules Update - Adopted Rules (5/12/17)
  • Rules included:
  • 4.202 Dental Services for Beneficiaries Age 21 and Older
  • 4.203 Dental Services for Beneficiaries Under Age 21, and Pregnant and Postpartum Women
  • 4.205 Orthodontic Treatment
  • Effective Date: 5/12/17
     
• GCR 16-119: Women's Health Initiative
  • Effective Date: 1/1/17
     
• GCR 16-113: Developmental Disabilities Services Rule Update
  • Effective Date: 10/1/17
     
• GCR 16-110: Global Commitment to Health Demonstration Waiver (10/25/16)
  • Post Award Forum - Global Commitment to Health Demonstration Waiver (1/25/17)
  • The waiver and related documents are available here.
  • Effective Date: 1/1/17 - 12/31/2021
     
• GCR 16-109: Recovery Audit Contractor - State Plan Amendment 17-0003
  • Effective Date: 1/1/17
     
• GCR 16-106: Alternative Benefit Plan Benchmark and Benefit Delivery - State Plan Amendment 17-0001
  • Effective Date: 1/1/17
     
• GCR 16-101: Health Benefits Eligibility & Enrollment Part 8 - Fair Hearing/Expedited Administrative Appeals
  • Effective Date: 1/15/17
     
• GCR 16-100: Health Benefits Eligibility & Enrollment Part 7 - Eligibility-and-Enrollment Procedures
  • Effective Date: 1/15/17
     
• GCR 16-099: Health Benefits Eligibility & Enrollment Part 6 - Small Employer Health-Benefits Program Rules
  • Effective Date: 1/15/17
     
• GCR 16-098: Health Benefits Eligibility & Enrollment Part 5 - Financial Methodologies
  • Effective Date: 1/15/17
     
• GCR 16-097: Health Benefits Eligibility & Enrollment Part 4 - Special Rules for Medicaid Coverage for Long-Term Care Services and Supports--Eligibility and Post-Eligibility
  • Effective Date: 1/15/17
     
• GCR 16-096: Health Benefits Eligibility & Enrollment Part 3 - Nonfinancial Eligibility Requirements
  • Effective Date: 1/15/17
     
• GCR 16-095: Health Benefits Eligibility & Enrollment Part 2 - Eligibility Standards
  • Effective Date: 1/15/17
     
• GCR 16-094: Health Benefits Eligibility & Enrollment Part 1 - General Provisions and Definitions
  • Effective Date: 1/15/17
     
• GCR 16-093: Disproportionate Share Hospital 2017 - State Plan Amendment 16-0029
  • Effective Date: 10/1/16
     
• GCR 16-092: Hospice Rates 2017
  • Effective Date: 10/1/16
     
• GCR 16-090: Medicaid Access to Care Plan
  • Medicaid Access to Care Plan - Final Report
  • Effective Date: 10/24/16
     
• GCR 16-089: Inpatient Prospective Payment System - State Plan Amendment 16-0023
  • Effective Date: 10/1/16
     
• GCR 16-077: Assistant Surgeon Modifiers
  • Effective Date: 12/1/16
     
• GCR 16-076: Health Care Administrative Rules Update
  • Rules included: 4.213 Audiology Services/Hearing Aids, 4.214 Eyewear and Vision Care Services, and Repeal - Planned Parenthood of Vermont
  • Effective 12/2/16
  • Health Care Administrative Rules Update
  • Rules included: 1.100 Introduction and 1.101 Definitions
  • Effective 12/16/16
     
• GCR 16-074: Rate Increase for Enhanced Primary Care Payments - State Plan Amendment 16-0021
  • Effective Date: 10/1/16
     
• GCR 16-072: Pharmacy Reimbursement - State Plan Amendment 17-0005 (6/8/17)
  • State Plan Amendment 17-0005 Approval Notice (5/29/18)
  • Effective Date: 4/1/17
     
• GCR 16-058: Cardiac Imaging Prior Authorization
  • Effective date: 10/1/16
     
• GCR 16-055: Howard Center ARCh Program Rate
  • Effective Date: 7/1/16
     
• GCR 16-054: Northeastern Family Institute Bundled Rate
  • Effective Date: 7/1/16
     
• GCR 16-051: Medicaid Contraceptives Policy and Prescription Drug Supply Limits - State Plan Amendment 16-0019
  • Effective Date: 10/1/16
     
• GCR 16-050: Integrating Family Services Rate Allocation
  • Effective Date: 7/1/16
     
• GCR 16-048: Increase to NCSS Budget for ABA Medicaid Beneficiaries
  • Effective Date: 7/1/16
     
• GCR 16-047: Applied Behavior Analysis Rates - State Plan Amendment (SPA) 16-0015
  • Effective Date: 6/15/16
     
• GCR 16-046: Ambulance Provider Reimbursement Rates - State Plan Amendment 16-0013
  • Effective Date: 7/1/16
     
• GCR 16-044: Medicaid Reasonable Opportunity Period
  • Effective Date: 5/11/16
     
• GCR 16-043: Code Correction for Specialized Rehabilitation Services
  • Effective Date: 7/1/16
     
• GCR 16-040: Vermont Medicaid Next Generation Model ACO Program
  • Effective Date: 1/1/17
  • Program Coverage Document
  • Program Reimbursement Document
     
• GCR 16-041: Elimination of Provider-Based Billing for Hospital-Owned Clinics
  • Effective Date: Effective for claims with dates of service 7/1/16 and after.
     
• GCR 16-036: Hemochromatosis Genetic Test
  • Effective Date: 7/1/16
     
• GCR 16-035: Vestibuloplasty Coverage
  • Effective Date: 6/1/16
     
• GCR 16-034: Outpatient Prospective Payment System - State Plan Amendment 16-0011
  • Effective Date: 7/1/16
     
• GCR 16-030: CPT Codes that Require Prior Authorization
  • Effective Date: 8/1/16
     
• GCR 16-029: Health Care Administrative Rules Update (7/25/16)
  • Rules included: 4.224 Sterilizations and Related Procedures
  • Effective 8/6/16
  • Health Care Administrative Rules Update (7/20/16)
  • Rules included: 4.227 Hospice Services and 4.222 Whole Blood
  • Effective 7/30/16
     
• GCR 16-027: Modifier/Code Logic for Outpatient Claims
  • Effective Date: 7/1/16
     
• GCR 16-023: Family Supportive Housing Providers
  • Effective Date: 10/1/16
     
• GCR 16-021: Hospital-Based Intensive Outpatient/PHP Reimbursement
  • Effective Date: 10/1/16
     
• GCR 16-020: Medicaid for Working People with Disabilities Eligibility Expansion (State Plan Amendment 16-0002)
  • Effective Date: 8/1/16
     
• GCR 16-017: Serenity House Transportation
  • Effective Date: 6/1/16
     
• GCR 16-016: Inpatient Postpartum Long-acting Reversible Contraceptive Add-on
  • Effective Date: 1/1/16
     
• GCR 16-012: VPharm Rule Update
  • Effective Date: 9/1/16
     
• GCR 16-011: Health Benefits Eligibility & Enrollment Rule Update
  • Effective Date: 8/1/16
     
• GCR 16-010: ARIS Solutions Rate Increase
  • Effective Date: 2/1/16
     
• GCR 16-009: New IEP Medical Necessity Authorization Code
  • Effective Date: 6/1/16
     
• GCR 16-007: Follow-up Treatment After Select Dental Procedures
  • Effective Date: 6/1/16
     
• GCR 16-006: Section 1332 ACA Waiver Request
  • Vermont 1332 Waiver for State Innovation Application (submitted 3/15/16)
  • REVISED Vermont 1332 Waiver for State Innovation Application (submitted 4/25/16)
  • 1332 Waiver Summary Presentation
  • HHS preliminary review (June 9, 2016)
  • State of Vermont response (July 5, 2016)
  • State of Vermont letter to HHS (October 19, 2016)
     
• GCR 16-005: Outpatient Prospective Payment System (OPPS) 2016 - State Plan Amendment (SPA) 16-011
  • Effective Date: 3/1/16
     
• GCR 16-004: Caps for Attendant Services Program and Choices for Care
  • Effective Date: 4/10/16
     
• GCR 16-003: Licensed Dental Hygienist Provider Type
  • Effective Date: 7/1/16
     
• GCR 16-002: Removal of Copays for Services Related Sexual Assault - State Plan Amendments 16-0017 and 16-0025
  • Effective Date: 10/1/16
     
• GCR 16-001: Medicaid Reasonable Opportunity Period
  • Effective Date: 1/11/16
     
• GCR 15-017: Medicaid Shared Savings Program Year 3 - State Plan Amendment (SPA) 16-009
  • Effective Date: 1/1/16
     
• GCR 15-015: Hospice Rates January 2016 - State Plan Amendment (SPA) 16-001
  • Effective Date: 1/1/16
     
• GCR 15-014: School Health Services Rates
  • Effective Date: 12/17/15
     
• GCR 15-013: Supervised Billing for Mental Health Providers
  • Effective Date: 1/1/16
     
• GCR 15-011: Use of GY Modifier
  • Effective Date: 7/1/16
     
• GCR 15-010: National Correct Coding Initiative Add-on Code Edits
  • Effective Date: 4/1/16
     
• GCR 15-009:  Update to Neonate Add-on Payments
  • Effective Date: N/A - REPEALED; NEVER IMPLEMENTED
     
• GCR 15-008: Waiting Placement Add-on for Cost-to-Charge Ratio
  • Effective Date: 10/1/14
     
• GCR 15-007: Physician Administered Drug Fee Schedule - State Plan Amendment (SPA) 16-007
  • Effective Date: 2/1/16
  • Correction to this policy issued 3/9/16
     
• GCR 15-006: Clinical Diagnostic Laboratory Fee Schedule - State Plan Amendment (SPA) 16-005
  • Effective Date: 1/1/16
     
•  GCR 15-004: Respite Services
  • Effective Date: 1/1/16
     
• GCR 15-003: Interrupted Psychiatric Stays
  • Effective Date: 1/1/16
     
• GCR 15-002: ARIS FLSA Rules for Overtime
  • Effective Date: 10/11/15
     
• GCR 15-001: Payroll Services for Traumatic Brain Injury (TBI) Program
  • Effective Date: 11/2/15